Economy Takes Toll on City's HIV Center

Last spring, when officials at St. Vincent's HospitalManhattan began organizing a fundraiser for its Comprehensive HIV Center, it didn't seem that unreasonable to start ticket prices at $500 each.

Now, as the economic turmoil deepens, $500 "is a huge amount of money for people," said Matt Baney, the center's administrative director.

"I'm not sure exactly what the turnout's going to be like," Baney said of the Tuesday fundraiser at Manhattan's Gotham Hall. "We're being much more realistic in our expectations."

At the same time, St. Vincent's HIV center faces city funding cuts as New York grapples with a projected multibillion dollar budget deficit -- cuts that will force the center to eliminate a program that provides time-sensitive treatment for people who have been potentially exposed to HIV. The city's infection rate is three times the national average, a center spokeswoman said.

The dilemma at St. Vincent's illustrates how the financial turmoil has spread. While most of the attention has been focused on the federal bailout of financial institutions, the plight of the ailing auto industry and the legions of homeowners with foreclosed properties, health care providers like the St. Vincent's center are also feeling the squeeze.

And the consequences for people at risk for contracting HIV are potentially life-altering, center officials said.

"Right now I'm scared to death," Baney said of the funding worries.

The St. Vincent's HIV Center, which also is marking its 20th anniversary this week, has long been at the epicenter of the decades-old U.S. AIDS epidemic.

The hospital is located in Manhattan's Greenwich Village and just south of Chelsea -- two neighborhoods with large gay populations. It was considered "ground zero" for HIV/AIDS care; some of the first known HIV cases were diagnosed at St. Vincent's in the early 1980s, the hospital says.

At that time, patients, mostly gay men, were showing up at the hospital's emergency room with Pneumocystis pneumonia, the purple lesions of Kaposi's sarcoma, blindness, on walkers, canes and crutches because of neuropathy, sometimes with IV poles in tow, recalled Baney, who's been at St. Vincent's for 17 years.

In the mid-1990s, as many as 220 patients on any given day were hospitalized at the 800-bed St. Vincent's with AIDS-related illnesses compared to 35 today, center officials say. With the arrival of a new class of drugs in the mid-1990s, people began living longer.

Still, this year the federal Centers for Disease Control revised its estimate of the country's annual new infections upward from 40,000 to 56,300.

New York City's infection rate is more three times the national average: 72 new infections for every 100,000 New York City residents compared to 23 per 100,000 people nationally, according to a New York City Department of Health and Mental Hygiene estimate released in August.

So for clinics like St. Vincent's HIV Center, whose 85 staff members see nearly 5,000 patients a year, prevention is crucial to curbing the epidemic.

But recently city officials told the center it was ending $200,000 in annual funding for treatment known as Post-Exposure Prophylaxis for people potentially exposed to HIV. The center is appealing the city's decision, said Dr. Antonio Urbina, the center's director of HIV education and training.

About 20 percent of the center's $7 million budget for outpatient services comes from the city health department. The state health department and the U.S. Department of Health and Human Services each provide about 30 percent; the remainder comes from Medicaid reimbursement, Baney said.

People who believe they've been exposed to the virus can seek the free drug treatment, which costs $750 to $1,500 for a 30-day supply, no more than 36 hours after the potential exposure. If treated in time, they have an 80 percent to 85 percent chance of not being infected if they were in fact exposed to HIV, center officials say.

"What do we do with the patients who show up...and they've been exposed to HIV?" Baney said. "They have no insurance, no money, they can't afford the $750 to $1,500 for medication for 30 days."

Treatment for an HIV-positive patient in New York City, Baney said, is $30,000 to $40,000 a year.